Prostate cancer is one of the most common cancers among men in the U.S. So it's understandable that people have questions about screening options, like the prostate-specific antigen (PSA) test.
The PSA test is a commonly used tool to screen for prostate cancer. But many patients in my urology practice are unsure how it works — or if they should be screened. I believe it's important for everyone to know more about this option.
Here are some of the questions I'm often asked and what I want everyone to know when considering a PSA screening.
What is a PSA test?
The PSA test is a simple blood test that measures a person's PSA levels in the blood. PSA is a protein that is made by cells in the prostate gland.
PSA levels are often elevated when a person has prostate cancer, so an elevated PSA can be an early sign of prostate cancer.
How can PSA screening help patients?
Most patients with early-stage prostate cancer will not have any signs or symptoms that they have cancer. PSA screening allows us to identify many of these early-stage cancers, when they are easier to treat and cure. If patients wait until they have symptoms to be tested for prostate cancer, these cancers are often more advanced and more difficult to treat.
Many lives have likely been saved by PSA screening and early treatment of prostate cancer. In fact, since the test was first introduced, deaths from prostate cancer in the U.S. have fallen by more than 40%.
What about at-home tests?
At-home PSA test kits allow you to collect a blood sample on your own via a finger stick. You can then send the sample to a lab for testing. Though it can be convenient, at-home findings aren't always black and white. It can be hard to tell on your own whether the results say you do or don't have prostate cancer. For that reason, I urge patients to go the traditional testing route instead.
What do PSA test results mean?
Higher PSA levels suggest an increased risk of prostate cancer. There is controversy about the PSA level that should be considered abnormal. Although a PSA level above 4.0 ng/mL is typically considered abnormal, the cutoff may be slightly higher or lower for some people, depending on their age.
Abnormal levels warrant concern — but they're not a reason to panic. Most prostate cancers are slow-growing. And sometimes PSA levels can be elevated even when cancer is not present.
If your PSA levels are higher than expected, your doctor may recommend additional testing. Often, the PSA test will be repeated in 6-8 weeks to confirm elevation. Your doctor will use your PSA level along with other aspects of your health to decide the next steps. These next steps may include continued monitoring of PSA levels over time, a digital rectal exam (DRE) to feel for a lump in the prostate, additional blood- or urine-based tests, or imaging tests like an MRI or ultrasound. If these tests are concerning, often a prostate biopsy is recommended, which is the only way to accurately diagnose prostate cancer.
Who needs a PSA test?
Although there are numerous benefits to PSA screening, there are also potential harms if men are screened inappropriately.
If you're between the ages of 55 and 69, the U.S. Preventive Services Task Force (USPSTF) recommends that you discuss the risks and benefits of PSA screening with your health care provider before deciding if the PSA test is right for you.
Start that conversation earlier if you are at an increased risk for prostate cancer. I often recommend starting screening around age 40 for patients with certain risk factors, including men who:
- Are Black
- Have an inherited variant of the BRCA1 or BRCA2 gene
- Have a parent or sibling who had prostate cancer
Are there other things to consider?
PSA testing can catch prostate cancer earlier, when it may be easier to treat. That's a significant benefit.
But screening also comes with some risks, and it's important to understand them before you make your choice about testing.
The main drawbacks: PSA tests can lead to overdiagnosis and overtreatment of prostate cancer. Sometimes the test detects a slow-growing cancer that would never actually cause symptoms or become dangerous in a person's lifetime. Treating that cancer could include surgery, radiation, or other treatments. These treatments can lead to side effects such as urinary incontinence, bowel problems, or trouble getting or maintaining an erection.
When should I stop screening?
Many experts recommend stopping PSA tests to screen for prostate cancer around age 70. The fact is, it's common for people in their 70s and 80s to have a nonaggressive form of prostate cancer. But because these cancers grow so slowly, they won't cause symptoms or become dangerous within the person's lifetime.
Take charge of your prostate health
Reach out to a Temple Health urologist if you have questions or concerns about your PSA test results, your risk for prostate cancer, or any other urologic concerns. You can request an appointment online or call 800-TEMPLE-MED (800-836-7536).
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